/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
 * Includes a Form with javascript
 * @param {Object} formId
 * @param {Object} initialHeight
 * @param {Object} iframeCode
 */
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
    this.formId = formId;
    this.initialHeight = initialHeight;
    this.iframeCode = iframeCode;
    this.frame = null;
    this.timeInterval= 200;
    this.appendTo = appendTo || false;
    
    // initialize function for object
    this.init = function(){
        this.createFrame();
        this.addFrameContent(this.iframeCode);
    };
    
    // Create the frame
    this.createFrame = function(){
        var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\"></if"+"rame>";
        if(this.appendTo === false){
            document.write(htmlCode);
        }else{
            var tmp = document.createElement('div');
            tmp.innerHTML = htmlCode;
            var a = this.appendTo;
            document.getElementById(a).appendChild(tmp.firstChild);            
        }
        // also get the frame for future use.
        this.frame = document.getElementById(this.formId);
        // set the time on the on load event of the frame
        this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
    };
    
    // add event function for different browsers
    this.addEvent = function( obj, type, fn ) {
        if ( obj.attachEvent ) {
            obj["e"+type+fn] = fn;
            obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
            obj.attachEvent( "on"+type, obj[type+fn] );
        }
        else{
            obj.addEventListener( type, fn, false );   
        }
    };
    
    this.addFrameContent = function (string){
        string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+
                '<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
                '<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
                'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
                ' }<'+'/script>');
        string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
        var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
        frameDocument.document.open();
        frameDocument.document.write(string);
        setTimeout( function(){
            frameDocument.document.close();
            try{
                if('JotFormFrameLoaded' in window){
                    JotFormFrameLoaded();
                }
            }catch(e){}
        },200);
    };
    
    this.setTimer = function(){
        var self = this;
        this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
    };
    
    this.changeHeight = function (){
        var actualHeight = this.getBodyHeight();
        var currentHeight = this.getViewPortHeight();
        if(actualHeight === undefined){
            this.frame.style.height = "100%";
            if(!this.frame.style.minHeight){
                this.frame.style.minHeight = "300px";
            }
        }else if  (Math.abs(actualHeight - currentHeight) > 18){
            this.frame.style.height = (actualHeight)+"px";
        }
        this.setTimer();
    };
    
    this.bindMethod = function(method, scope) {
        return function() {
            method.apply(scope,arguments);
        };
    };
    
    this.getBodyHeight = function (){
        var height;
        var scrollHeight;
        var offsetHeight;
        try{  // Prevent IE from throw errors
            if (this.frame.contentWindow.document.height){
                
                height = this.frame.contentWindow.document.height;
                //Emre: to prevent "iframe height"  problem (61059)
                if (this.frame.contentWindow.document.body.scrollHeight){
                    height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
                }
                
                if (this.frame.contentWindow.document.body.offsetHeight){
                    height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
                }
                
            } else if (this.frame.contentWindow.document.body){
                
                if (this.frame.contentWindow.document.body.scrollHeight){
                    height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
                }
                
                if (this.frame.contentWindow.document.body.offsetHeight){
                    height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
                }
                
                if (scrollHeight && offsetHeight){
                    height = Math.max(scrollHeight, offsetHeight);
                }
            }            
        }catch(e){ }
        return height;
    };
    
    this.getViewPortHeight = function(){
        var height = 0;
        try{ // Prevent IE from throw errors
            if (this.frame.contentWindow.window.innerHeight)
            {
                height = this.frame.contentWindow.window.innerHeight - 18;
            }
            else if ((this.frame.contentWindow.document.documentElement) &&
                     (this.frame.contentWindow.document.documentElement.clientHeight))
            {
                height = this.frame.contentWindow.document.documentElement.clientHeight;
            }
            else if ((this.frame.contentWindow.document.body) &&
                     (this.frame.contentWindow.document.body.clientHeight))
            {
                height = this.frame.contentWindow.document.body.clientHeight;
            }            
        }catch(e){ }
        return height;
    };
    
    this.init();
}
FrameBuilder.get = [];
var i1695451923 = new FrameBuilder("1695451923", false, "", "<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Form<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n    .form-label{\n        width:150px !important;\n    }\n    .form-label-left{\n        width:150px !important;\n    }\n    .form-line{\n        padding:10px;\n    }\n    .form-label-right{\n        width:150px !important;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:false;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:20px;\n        width:650px;\n        color:Black !important;\n        font-family:Verdana;\n        font-size:12px;\n    }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.setConditions([{\"action\":{\"field\":\"76\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"77\",\"operator\":\"equals\",\"value\":\"Payment by Credit Card via PayPal\"}],\"type\":\"field\"},{\"action\":{\"field\":\"78\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"77\",\"operator\":\"equals\",\"value\":\"Make Check payable to Portage APL (Please indicate \\u201cPaws for Golf\\u201d on memo line)\"}],\"type\":\"field\"}]);\n   JotForm.init(function(){\n      $('input_72').hint('ex: myname@example.com');\n      $('input_67').hint('ex: myname@example.com');\n      $('input_62').hint('ex: myname@example.com');\n      $('input_50').hint('ex: myname@example.com');\n   });\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_1695451923\" id=\"1695451923\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"1695451923\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section\">\n      <li class=\"form-line\" id=\"id_84\">\n        <div id=\"cid_84\" class=\"form-input-wide\">\n          <div id=\"text_84\" class=\"form-html\">\n            <p style=\"text-align: center;\"><span style=\"font-size: medium;\"><strong>\n                  3rd Annual \"Paws for Golf\" Charity Outing &nbsp;\n                <\/strong><\/span>\n              <br \/><span style=\"font-size: medium;\"><strong>\n                  To Benefit Portage Animal Protective League\n                <\/strong><\/span>\n              <br \/><span style=\"font-size: small;\">Aurora Golf Club, Aurora OH&nbsp; &nbsp;<\/span>\n              <br \/><span style=\"font-size: small;\">Saturday, August 14<\/span>\n              <br \/><span style=\"font-size: small;\">Bag Drop 12 Noon &ndash; Start at 1 PM<\/span>\n              <br \/>\n              <strong><span style=\"font-size: small;\">Registration - $100 per golfer<\/span>\n              <\/strong>\n              <br \/><span style=\"font-size: small;\">Please complete information for each golfer<\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_80\">\n        <div id=\"cid_80\" class=\"form-input-wide\">\n          <div id=\"text_80\" class=\"form-html\">\n            <p>\n              <strong><span style=\"font-size: medium;\">Golfer #1<\/span>\n              <\/strong>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_68\">\n        <label class=\"form-label-left\" id=\"label_68\" for=\"input_68\"> Full Name <\/label>\n        <div id=\"cid_68\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q68_fullName68[first]\" id=\"first_68\" \/>\n            <label class=\"form-sub-label\" for=\"first_68\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q68_fullName68[last]\" id=\"last_68\" \/>\n            <label class=\"form-sub-label\" for=\"last_68\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_69\">\n        <label class=\"form-label-right\" id=\"label_69\" for=\"input_69\"> Address <\/label>\n        <div id=\"cid_69\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q69_address69[addr_line1]\" id=\"input_69_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_69_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q69_address69[addr_line2]\" id=\"input_69_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_69_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q69_address69[city]\" id=\"input_69_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_69_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q69_address69[state]\" id=\"input_69_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_69_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q69_address69[postal]\" id=\"input_69_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_69_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q69_address69[country]\" id=\"input_69_country\">\n                    <option selected> Please Select <\/option>\n                    <option selected=\"selected\" value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_69_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_70\">\n        <label class=\"form-label-right\" id=\"label_70\" for=\"input_70\"> Cell Phone <\/label>\n        <div id=\"cid_70\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q70_cellPhone70[area]\" id=\"input_70_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_70_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q70_cellPhone70[phone]\" id=\"input_70_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_70_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_71\">\n        <label class=\"form-label-right\" id=\"label_71\" for=\"input_71\"> Home Phone <\/label>\n        <div id=\"cid_71\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q71_homePhone71[area]\" id=\"input_71_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_71_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q71_homePhone71[phone]\" id=\"input_71_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_71_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_72\">\n        <label class=\"form-label-right\" id=\"label_72\" for=\"input_72\"> E-mail <\/label>\n        <div id=\"cid_72\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[Email]\" id=\"input_72\" name=\"q72_email72\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_11\">\n        <label class=\"form-label-right\" id=\"label_11\" for=\"input_11\"> Company <\/label>\n        <div id=\"cid_11\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_11\" name=\"q11_company\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_81\">\n        <div id=\"cid_81\" class=\"form-input-wide\">\n          <div id=\"text_81\" class=\"form-html\">\n            <p>\n              <strong><span style=\"font-size: medium;\">Golfer #2<\/span>\n              <\/strong>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_63\">\n        <label class=\"form-label-right\" id=\"label_63\" for=\"input_63\"> Full Name <\/label>\n        <div id=\"cid_63\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q63_fullName63[first]\" id=\"first_63\" \/>\n            <label class=\"form-sub-label\" for=\"first_63\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q63_fullName63[last]\" id=\"last_63\" \/>\n            <label class=\"form-sub-label\" for=\"last_63\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_64\">\n        <label class=\"form-label-right\" id=\"label_64\" for=\"input_64\"> Address <\/label>\n        <div id=\"cid_64\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q64_address64[addr_line1]\" id=\"input_64_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_64_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q64_address64[addr_line2]\" id=\"input_64_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_64_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q64_address64[city]\" id=\"input_64_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_64_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q64_address64[state]\" id=\"input_64_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_64_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q64_address64[postal]\" id=\"input_64_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_64_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q64_address64[country]\" id=\"input_64_country\">\n                    <option selected> Please Select <\/option>\n                    <option selected=\"selected\" value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_64_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_65\">\n        <label class=\"form-label-right\" id=\"label_65\" for=\"input_65\"> Cell Phone <\/label>\n        <div id=\"cid_65\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q65_cellPhone[area]\" id=\"input_65_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_65_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q65_cellPhone[phone]\" id=\"input_65_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_65_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_66\">\n        <label class=\"form-label-right\" id=\"label_66\" for=\"input_66\"> Home Phone <\/label>\n        <div id=\"cid_66\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q66_homePhone[area]\" id=\"input_66_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_66_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q66_homePhone[phone]\" id=\"input_66_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_66_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_67\">\n        <label class=\"form-label-right\" id=\"label_67\" for=\"input_67\"> E-mail <\/label>\n        <div id=\"cid_67\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[Email]\" id=\"input_67\" name=\"q67_email67\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_21\">\n        <label class=\"form-label-right\" id=\"label_21\" for=\"input_21\"> Company <\/label>\n        <div id=\"cid_21\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_21\" name=\"q21_company21\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_82\">\n        <div id=\"cid_82\" class=\"form-input-wide\">\n          <div id=\"text_82\" class=\"form-html\">\n            <p>\n              <strong><span style=\"font-size: medium;\">Golfer #3<\/span>\n              <\/strong>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_58\">\n        <label class=\"form-label-right\" id=\"label_58\" for=\"input_58\"> Full Name <\/label>\n        <div id=\"cid_58\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q58_fullName58[first]\" id=\"first_58\" \/>\n            <label class=\"form-sub-label\" for=\"first_58\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q58_fullName58[last]\" id=\"last_58\" \/>\n            <label class=\"form-sub-label\" for=\"last_58\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_59\">\n        <label class=\"form-label-right\" id=\"label_59\" for=\"input_59\"> Address <\/label>\n        <div id=\"cid_59\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q59_address59[addr_line1]\" id=\"input_59_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_59_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q59_address59[addr_line2]\" id=\"input_59_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_59_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q59_address59[city]\" id=\"input_59_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_59_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q59_address59[state]\" id=\"input_59_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_59_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q59_address59[postal]\" id=\"input_59_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_59_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q59_address59[country]\" id=\"input_59_country\">\n                    <option selected> Please Select <\/option>\n                    <option selected=\"selected\" value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_59_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_60\">\n        <label class=\"form-label-right\" id=\"label_60\" for=\"input_60\"> Cell Phone <\/label>\n        <div id=\"cid_60\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q60_cellPhone60[area]\" id=\"input_60_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_60_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q60_cellPhone60[phone]\" id=\"input_60_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_60_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_61\">\n        <label class=\"form-label-right\" id=\"label_61\" for=\"input_61\"> Home Phone <\/label>\n        <div id=\"cid_61\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q61_homePhone61[area]\" id=\"input_61_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_61_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q61_homePhone61[phone]\" id=\"input_61_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_61_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_62\">\n        <label class=\"form-label-right\" id=\"label_62\" for=\"input_62\"> E-mail <\/label>\n        <div id=\"cid_62\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[Email]\" id=\"input_62\" name=\"q62_email62\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_31\">\n        <label class=\"form-label-right\" id=\"label_31\" for=\"input_31\"> Company <\/label>\n        <div id=\"cid_31\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_31\" name=\"q31_company31\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_83\">\n        <div id=\"cid_83\" class=\"form-input-wide\">\n          <div id=\"text_83\" class=\"form-html\">\n            <p>\n              <strong><span style=\"font-size: medium;\">Golfer #4<\/span>\n              <\/strong>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_54\">\n        <label class=\"form-label-right\" id=\"label_54\" for=\"input_54\"> Full Name <\/label>\n        <div id=\"cid_54\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q54_fullName[first]\" id=\"first_54\" \/>\n            <label class=\"form-sub-label\" for=\"first_54\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q54_fullName[last]\" id=\"last_54\" \/>\n            <label class=\"form-sub-label\" for=\"last_54\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_55\">\n        <label class=\"form-label-right\" id=\"label_55\" for=\"input_55\"> Address <\/label>\n        <div id=\"cid_55\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q55_address55[addr_line1]\" id=\"input_55_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_55_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q55_address55[addr_line2]\" id=\"input_55_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_55_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q55_address55[city]\" id=\"input_55_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_55_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q55_address55[state]\" id=\"input_55_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_55_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q55_address55[postal]\" id=\"input_55_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_55_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q55_address55[country]\" id=\"input_55_country\">\n                    <option selected> Please Select <\/option>\n                    <option selected=\"selected\" value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_55_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_56\">\n        <label class=\"form-label-right\" id=\"label_56\" for=\"input_56\"> Cell Phone <\/label>\n        <div id=\"cid_56\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q56_cellPhone56[area]\" id=\"input_56_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_56_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q56_cellPhone56[phone]\" id=\"input_56_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_56_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_57\">\n        <label class=\"form-label-right\" id=\"label_57\" for=\"input_57\"> Home Phone <\/label>\n        <div id=\"cid_57\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q57_homePhone57[area]\" id=\"input_57_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_57_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q57_homePhone57[phone]\" id=\"input_57_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_57_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_41\">\n        <label class=\"form-label-right\" id=\"label_41\" for=\"input_41\"> Company <\/label>\n        <div id=\"cid_41\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_41\" name=\"q41_company41\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li id=\"cid_42\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h2 id=\"header_42\" class=\"form-header\">\n            DINNER ONLY REGISTRATION FOR $30.00\n          <\/h2>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_52\">\n        <label class=\"form-label-right\" id=\"label_52\" for=\"input_52\"> Full Name <\/label>\n        <div id=\"cid_52\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q52_fullName52[first]\" id=\"first_52\" \/>\n            <label class=\"form-sub-label\" for=\"first_52\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q52_fullName52[last]\" id=\"last_52\" \/>\n            <label class=\"form-sub-label\" for=\"last_52\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_53\">\n        <label class=\"form-label-right\" id=\"label_53\" for=\"input_53\"> Address <\/label>\n        <div id=\"cid_53\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q53_address[addr_line1]\" id=\"input_53_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_53_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q53_address[addr_line2]\" id=\"input_53_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_53_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q53_address[city]\" id=\"input_53_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_53_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q53_address[state]\" id=\"input_53_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_53_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q53_address[postal]\" id=\"input_53_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_53_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q53_address[country]\" id=\"input_53_country\">\n                    <option selected> Please Select <\/option>\n                    <option selected=\"selected\" value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_53_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_51\">\n        <label class=\"form-label-right\" id=\"label_51\" for=\"input_51\"> Home Phone <\/label>\n        <div id=\"cid_51\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q51_homePhone51[area]\" id=\"input_51_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_51_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q51_homePhone51[phone]\" id=\"input_51_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_51_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_50\">\n        <label class=\"form-label-right\" id=\"label_50\" for=\"input_50\"> Email <\/label>\n        <div id=\"cid_50\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[Email]\" id=\"input_50\" name=\"q50_email\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li id=\"cid_74\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h2 id=\"header_74\" class=\"form-header\">\n            Payment Options\n          <\/h2>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_77\">\n        <label class=\"form-label-left\" id=\"label_77\" for=\"input_77\"> Payment Options <\/label>\n        <div id=\"cid_77\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_77_0\" name=\"q77_paymentOptions\" value=\"Payment by Credit Card via PayPal\" \/>\n              <label for=\"input_77_0\"> Payment by Credit Card via PayPal <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_77_1\" name=\"q77_paymentOptions\" value=\"Make Check payable to Portage APL (Please indicate \u201cPaws for Golf\u201d on memo line)\" \/>\n              <label for=\"input_77_1\"> Make Check payable to Portage APL (Please indicate \u201cPaws for Golf\u201d on memo line) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_77_2\" name=\"q77_paymentOptions\" value=\"Call Aurora GC at 330.562.2672 or 330.562.5300 and say you want to register for Paws for Golf\" \/>\n              <label for=\"input_77_2\"> Call Aurora GC at 330.562.2672 or 330.562.5300 and say you want to register for Paws for Golf <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio\" id=\"input_77_3\" name=\"q77_paymentOptions\" value=\"Call Sandra at Portage APL at 330.296.4022, extension 101\" \/>\n              <label for=\"input_77_3\"> Call Sandra at Portage APL at 330.296.4022, extension 101 <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_76\">\n        <label class=\"form-label-left\" id=\"label_76\" for=\"input_76\"> Total Golf Registration Amount <\/label>\n        <div id=\"cid_76\" class=\"form-input\"><span class=\"form-sub-label-container\"><input type=\"text\" class=\"form-textbox validate[Numeric]\" size=\"4\" id=\"input_76_donation\" name=\"q76_totalGolf[price]\" value=\"\">\n            USD\n            <label class=\"form-sub-label\" for=\"input_76_donation\"> Paws for Golf Registration Fee <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_78\">\n        <div id=\"cid_78\" class=\"form-input-wide\">\n          <div id=\"text_78\" class=\"form-html\">\n            <p><span style=\"font-size: small;\"><strong>\n                  MAIL REGISTRATION FORM AND PAYMENT TO:\n                <\/strong><\/span>\n              <br \/><span style=\"font-size: small;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Nick Leacoma<\/span>\n              <br \/><span style=\"font-size: small;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 10230 Gloucester Rd.<\/span>\n              <br \/><span style=\"font-size: small;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Streetsboro, OH 44241&nbsp;<\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\">\n              Submit Form\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"1695451923\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1695451923-1695451923\";\n  <\/script>\n<\/form><\/body>\n<\/html>\n");